kO 


HX64055078 
RD101  B32  1906     Fractures  and  disloc 


RECAP 


Battle  6:  co.,  St.  Louis. 


Fractures  and  dislocation  charts 


t*:dioi 


332 


in  tt)  e  Cttp  of  i^rtu  gork 

College  of  ipfjpstciang  anfc  burgeons; 
Htftrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/fracturesdislocaOObatt 


Fractures  and 
Dislocation  Charts 


IN  COLORS 


Compliments  of 
BATTLE  C&  COMPANY 

Chemists'  Corporation 
ST.  LOUIS,  MO. 


FRACTURE  OF  FEMUR 

BELOW  TROCHANTERS. 


a. 

Rectos. 

b. 

Adductors. 

c. 

Biceps. 

d. 

Psoas  and  Iliacua. 

e. 

Pyriformis. 

f. 

Semi-membranosus 

ST. 

Semi-tendinosus. 

h. 

Qnadratus  femoris. 

1. 

Psoas. 

k. 

Symphysis  pubis. 

Fracture  of  the  Femur  Just  Below  the  Trochanters 

*  *in  £?is  fracture.  tne  upper  fragment  is  tilted  forward  and  everted  bv  the  combined  action 
of  tne  Psoas  and  Iliacus,  and,  at  the  same  time,  is  farther  everted  and  drawn  outward  by  the 
External  rotator  muscles  of  the  thigh.  The  lower  fragment  is  drawn  upward  by  the  Rectus 
Lo™/0?^-  ?  *Bi,ceps'J  Semimembranosus,    Semitendinosus   and  Gracilis  behind,  and,  at  the 

fh^  iii!1;  1S  rotated>  and  the  upper  end  tilted  outward  and  the  lower  end  drawn  inward  by 
tne  Aauuctor  muscles. 

™;+v,T^!L!iisplacemfnt  causes  a  marked  prominence  at  the  upper  and  outer  side  of  the  thigh, 
WJ£„f£° TteJ£ns  a,nd  e+Yersl°n  of  the  limb.  It  may  be  reduced  and  retained  by  three  different 
SI t,p .    n™rrn££eia?i?  ?       ^  the  °PP°sinS  muscles  by  securing  the  limb  on  a  double  inclined 

Pf™   A^tI     >     7°  contraction   of   the   muscles   by   continued    extension,    as    in    Buck's   exten- 

pension  splint  '  °r  Uni°n   °f  theSe    tW°   PrinciPles   in   the   use    of   Hodgen's    sus- 


(2) 


COPYRIGHT,     190 
BATTLE     h.     CO. 


OBLIQUE    FRACTURE 

OF  SHAFT   OF   TIBIA. 


Rectus. 

Ligamentum  Patellae. 

Gastrocnemius. 

Popliteus. 

Soleus. 

Pluntaris. 


Oblique  Fracture  of  the  Shaft  of  the  Tibia 

In  this  fracture  the  form  of  displacement  depends  on  the  direction  of  the  line  of  fracture. 
If  it  is  downward  and  forward,  as  represented,  the  fragments  overlap,  the  lower  fragment  be- 
ing drawn  backward  and  upward  by  the  action  of  the  Gastrocnemius  and  Soleus  muscles, 
while  the  pointed  extremity  of  the  upper  fragment  projects  forward  immediately  beneath  the 
integument,  often  protruding  through  it  and  rendering  the  fracture  a  compound  one.  If  it  is 
the  reverse  of  that  represented,  the  pointed  extremity  of  the  lower  fragment  projects  forward, 
overlapping  the  lower  extremity  of  the  upper  one.  The  fragments  are  brought  in  opposition 
by  extension  and  counter-extension,  preferably  while  the  muscles  are  relaxed  by  the  semi- 
flexion of  the  knee,  it  often  being  necessary  in  compound  fractures  to  remove  a  part  of  the 
protruding   bone    before    complete    adaptation    can    be   effected. 

The  fragments  are  retained  in  position  by  means  of  the  plaster  cast,  lateral  splints  or 
the  fracture  box.  The  knee  should  be  immobilized,  but  continued  extension  from  the  foot  is 
seldom  necessary. 


COPYRIGHT,     1900, 
BATTLE     t     CO. 


(3) 


FRACTURE  OF  FEMUR 
JUST  ABOVE  CONDYLES. 


Rectus. 

Biceps. 

Semimembranosus. 

Semitendinosus. 

Patella. 

Gastrocnemius. 

Head  of  Fibula. 


Fracture  of  the  Femur  Just  Above  the  Condyles 

A  rather  serious  injury  and  attended  by  considerable  displacement.  The  lower  fragment 
is  carried  backward  deeply  into  the  popliteal  space  by  the  powerful  action  of  the  Gastroc- 
nemius and  Plantaris  (?)  muscles,  and  at  the  same  time  upward  by  the  Rectus,  Biceps,  Semi- 
membranosus and  Semitendinosus.  The  pointed  end  of  the  upper  fragment  is  drawn  inward 
by  the  Pectineus  and  Adductor  muscles,  and  tilted  forward  by  the  Psoas  and  Iliacus.  Reduc- 
tion is  best  effected  by  the  double  inclined  plane,  or  by  continued  traction  from  the  ankle 
joint.  Great  care  should  be  exercised  in  securing  apposition  of  the  fragments  in  order  to 
avoid  the  pinching  of  a  portion  of  the  Rectus  muscles  between  the  fragments.  Immobiliza- 
tion,  once   reduction   is   made,   is  accomplished   by   one   of   the   regular    methods. 


(4) 


FRACTURE  OF 

NECK  OF  FEMUR 


a. 

Gluteus  Medius. 

b. 

Gluteus  Minimus. 

e. 

Pyriformis. 

d. 

Gemellus  Superior. 

e. 

Obturator  Internus. 

f. 

Gemellus  Inferior. 

g. 

Obturator  Externus, 

h. 

Quadratus  Femoris. 

i. 

Gluteus  Masinius. 

k. 

Psoas. 

1. 

Iliacus. 

Fracture  of  Neck  of  Femur 


In  this  the  characteristic  marks  are  slight  shortening  of  the  limb  and  eversion  of  the 
foot.  Eversion  is  caused  by  the  'weight  of  the  limb  rotating  it  outward.  Shortening  is  pro- 
duced by  the  action  of  the  Glutei  muscles,  the  Rectus,  Biceps,  Semimembranosus  and  Semi- 
tendinosus.  Posterior  displacement  is  effected  by  the  Gemelli,  Obturator  and  other  rotators. 
This  fracture  is  more  frequent  in  old  age  than  in  young  or  early  adult  life.  Treatment  is  as 
follows:  Only  so  much  of  the  shortening  as  can  be  effected  by  moderate  traction  should  be 
made,  as  complete  reduction  is  liable  to  break  up  a  possible  impaction  that  would  be  valuable 
in  securing  union.  Traction  by  Buck's  extension  with  a  weight  of  from  five  to  ten  pounds  pre- 
vents further  shortening  and  promotes  comfort,  while  small  sand  bags  placed  around  the  pel- 
vis and  limb  further  aid  in  securing  immobility.  If  possible,  a  well  applied  plaster  dressing 
is  recommended  by  the  best  authorities,  and  should  be  worn  for  two  months,  if  the  patient's 
condition  will  permit. 


COPYRIGHT.     1QC 
BATTLE     i     CO. 


(5) 


FRACTURE  OF  FIBULA,  WITH 

DISLOCATION    OF   FOOT   OUTWARD. 
"POTT'S    FRACTURE." 

a.  Internal  Lateral  Ligament. 

b.  Peroneus  Longus. 

c.  Tibialis  Posticus. 


Fracture  of  the  Fibula — "Pott's  Fracture" 

This  is  one  of  the  most  frequent  injuries  to  the  ankle  joint.  The  end  of  the  Tibia  is  dis- 
placed from  the  corresponding  surface  of  the  Astragalus  by  the  rupturing  of  the  internal  lateral 
ligament,  permitting  the  projecting  inward  of  the  inner  malleolus.  The  Fibula  is  usually 
broken  from  two  to  three  inches  above  the  ankle.  The  foot  is  everted  by  the  action  of  the 
Peroneus  Longus,  its  inner  border  rests  upon  the  ground  while  at  the  same  time  the  heel  ia 
drawn  upward  by  the  muscles  of  the  calf.  Reduction  is  effected  by  flexing  the  leg  at  right 
angles  with  the  thigh,  and  by  the  application  of  extension  and  counter  extension  from  ankle 
to  knee.  Fixation  and  adaptation  is  best  maintained  by  a  plaster  cast,  and  maintaining  the 
foot  in   a  position  of  forced   inversion. 


(6) 


COPYRIGHT.    1©0  1 
BATTLE    &     CO. 


RACTl 


OF 

IE   PATELLA. 


b.  Vastus  Bxternus. 

c.  Ligamentum  Patella?. 


Fracture  of  the  Patella 


The  fragments  in  this  fracture  are  separated  by  the  effusion  which  takes  place  into  the 
joint,  and  by  the  action  of  the  Rectus  and  Vasti  muscles.  The  degree  of  separation  may  be 
as  much  as  three  inches.  The  only  treatment  worthy  of  mention,  of  the  many  that  are  de- 
vised, is  the  operative,  in  which  the  Patella  is  cut  down  upon,  the  fragments  approximated  and 
wired    in    position    and    the    limb    immobilized    by  a  plaster  dressing  for  several  months. 


(  7) 


FRACTURE    OF 

THE   CLAVICLE. 

a.  Sterno  mastoid. 

b.  Subclavius. 

c.  Peetoralis  minor. 

d.  Latissimus  dorsi. 

e.  Peetoralis  major. 

f.  Coracoid  process. 


Fracture  of  the  Middle  Third  of  the  Clavicle 

In  this  fracture,  when  complete,  the  shoulder  falls  downward,  forward  and  inward.  The 
inner  fragment  is  seldom  displaced,  being-  held  in  position  by  the  Costoclavicular  ligament  and 
the  antagonism  between  the  Sterno-mastoid  and  Peetoralis  major  muscles.  It  is,  however, 
sometimes  elevated  by  the  inner  extremity  of  the  outer  fragment  getting  beneath  it,  or  by  the 
action  of  an  extra  strong  Sterno-mastoid.  The  inner  end  of  the  outer  fragment  is  drawn  in- 
ward, beneath  or  behind  the  inner  fragment,  by  the  action  of  the  Subclavius,  the  Peetoralis 
major  and  minor,  and  the  Latissimus  Dorsi  muscles,  while  the  outer  end  is  forced  forward  and 
downward   by   the   action    of   the   Pectoral   muscles  and   the  weight   of  the  shoulder. 

The  indication  for  treatment  is  to  carry  the  shoulder  upward,  backward  and  outward, 
bringing  the  fragments  in  line,  and  fix  it  in  that  position.  This  may  be  done  by  applying 
bayre  s  adhesive  plaster  dressing,  Velpeau's  bandage  of  Moore's  method — descriptions  of  which 
may    be    found    in    recent    textbooks    on    surgery. 


(8) 


COPYRIGHT,    1902, 
BATTLE     i     CO. 


FRACTURE  OF  SURGICAL 

NECK   OF   HUMERUS. 


Caracoid  process. 
Acromion  process. 
Subscapulars. 
Latissimns   dorsi. 
Deltoid. 
Pectoralis  major. 


Fracture  of  the  Surgical  Neck  of  the  Humerus 

This  is  a  common  fracture,  and  its  deformity  resembles,  somewhat,  a  dislocation  of  the 
head  of  the  humerus  into  the  axilla.  The  upper  fragment  is  slightly  elevated  under  the 
Coraco-acromial  ligament  by  the  muscles  attached  to  the  greater  tuberosity;  the  upper  end 
of  the  lower  fragment  is  drawn  inward,  into  the  axillary  space,  by  the  action  of  the  Pectoralis 
major,  Latissimus  dorsi  and  Teres  major,  the  lower  end  is  tilted  outward  by  the  Deltoid,  while 
the  whole  fragment  is  drawn  more  or  less  upward  by  the  Deltoid,  Biceps,  Coraco-brachialis, 
and  long  head  of   the   Triceps. 

The  deformity  is  reduced  by  fixing  the  shoulder  and  drawing  the  arm  outward  and  down- 
ward. The  fragments  are  retained  in  position  by  applying  a  well-fitted  shoulder-cap  splint  to 
the  outer  side  of  the  arm,  a  well-padded  straight  splint  to  the  inner  side,  pressed  well  into  the 
axilla,  the  two  being  held  by  a  roller  carried  over  the  shoulder  in  the  form  of  a  spica  bandage. 
The  fore-arm   is   flexed   and   secured   to   the   side. 

Another  mode  is,  place  a  conical  pad  in  the  axilla,  base  upward,  place  the  forearm  in  a 
sling,  bring  the  elbow  to  the  side  and  secure  the  same  in  this  position  with  a  plaster  bandage 
carried    around   the    chest. 


COPYRIGHT,    1802. 
BATTLE     &.     CO. 


(9) 


%iB-f!?vv:'  •  '-'4.;'  n  •  ?    - 


FRACTURE   OF   HUMERUS 

ABOVE  THE  CONDYLES 

a.  Deltoid. 

b.  Biceps. 

e.  Triceps, 
d.      Brachialis  anticus. 

f.  Olecranon  process. 


Fracture  of  the  Humerus  Above  ihe  Condyles 


ward 

drawn 

hind.     This  injury  may  be   differentiated  from~dislo 


cation   by  the   increased  mobility   in  fracture, 


age,   or   incasing-   the  limb   in   a  plaster   of  Paris  dres 


sing  in   the   flexed   position. 


(  10). 


COPYRIGHT,    1905. 
BATTLE    &     CO. 


FRACTURE  OF 

OLECRANON. 

a.  Triceps. 

b.  Olecranon  process. 

c.  Head  of  ulna?. 

d.  Head   of   radius. 


^H&LJ^*  -  •  - 


Fracture  of  the  Olecranon  Process 

This  fracture  is  attended  by  wide  displacement.  The  detached  fragment  is  drawn  upward 
by  the  action  of  the  Triceps  muscle,  from  half  an  inch  to  two  inches,  the  prominence  of  the 
elbow  is  consequently  lost,  and  a  deep  hollow  is  felt  at  the  back  part  of  the  joint,  which  is 
increased  by  flexion.     At  the  same  time  the  power  of  extending  the  forearm  is  more  or  less  lost. 

Ireatment  consists  in  relaxing-  the  Triceps  by  extending  the  limb  and  retaining  it  in  this 
position  by  means  of  a  long  anterior  splint.  The  fragments  are  thus  brought  in  close  apposition 
and  may  be  further  approximated  by  drawing  down  the  upper  fragment  by  passing  the  band- 
age tightly  above  it  and  through  notches  made  on  each  side  of  the  splint  directly  over  the 
nexure  of  the  joint.  A  less  favored  treatment  is  to  wire  the  fragments  and  apply  a  plaster  of 
Paris    dressing.      The    union    is    usuallv    ligamentous 


COPYRIGHT,    ISO 
BATTLE    &    CO. 


(ID 


FRACTURE  OF 

SHAFT  OF  RADIUS. 

a.  Biceps. 

t>.  Pronator  radii  teres. 

c.  Supinator  longus. 

d.  Pronator  quadratus. 


Fracture  of  Shaft  of  Radius  Near  the  Center 

In  this  variety  of  fracture  the  upper  fragment  is  drawn  forward  by  the  biceps  and  ro- 
tated inward,  over  the  ulna,  by  the  pronator  radii  teres,  to  a  position  midway  between  prona- 
tion and  supination.  The  lower  fragment  is  drawn  inward  and  slightly  pronated  by  the 
pronator  quadratus;  at  the  same  time  the  supinator  longus,  by  elevating  the  styloid  process, 
depresses  the  upper  end  of  the  lower  fragment  still  more  toward  the  ulna.  This  fracture  is  best" 
reduced  by  flexing  the  forearm  on  the  arm,  placing  the  hand  in  a  position  midway  between 
pronation  and  supination  and  making  extension  from  the  elbow;  and  should  be  retained  in  this 
position  by  well-padded  lateral  splints  extending  from  elbow  to  wrist,  or  by  the  application 
of  a  light  plaster  cast  to  arm  and  forearm. 


(  12) 


^ 


M'i 


fe« 


.-< 


'££1 


If 


FRACTURE  OF  LOWER 
END   OF   RADIUS. 

"Colles's  Fracture/' 

a.  Supinator  longns. 

b.  Pronator    radii  teres. 

c.  Pronator  quadratns. 

d.  Extensors. 


:  i   '  Jr 


mi    if 

I   P 


^ 


;o 


Fracture  of  the  Lower  End  of  the  Radius  —  "Colles's  Fracture" 

In  this  injury  the  lower  fragment  is  drawn  upward  and  backward  behind  the  upper  fragment 
by  the  combined  action  of  the  supinator  longus  and  the  flexors  and  extensors  of  the  thumb  and 
carpus,  producing  the  characteristic  "silver  fish"  deformity.  The  upper  fragment  projects  for- 
ward, often  lacerating  the  pronator  quadratus  (as  in  the  picture)  and  is  drawn  by  this  muscle 
into  close  contact  with  the  lower  end  of  the  ulna.  Treatment  consists  in  flexing  the  forearm  and 
making  powerful  extension  at  wrist  and  elbow,  depressing  at  the  same  time  the  radial  side 
of  the  hand,  and  maintaining  the  hand  in  that  position  by  well-padded  pistol-shaped  splints. 


COPYRIGHT.    1PO< 
BATTLE     &     CO. 


(13) 


G/eno/d 


Co/?di//o/d 
Process 


Dislocation  of  the  Jaw 


In  this  accident  the  articular  surface  of  one,  or  of  both,  of  the  condyloid  processes  of  the 
inferior  maxilla  rests  upon  the  base  of  the  zygomatic  process,  being  drawn  forward  out  of 
the  glenoid   cavity. 

TREATMENT 

The  thumbs,  well  wrapped  to  protect  them  from  injury,  are  placed  between  the  posterior 
molar  teeth  on  each  side  of  the  jaw,  the  jaw  is  grasped  firmly  at  the  base  of  the  bone;  then 
with  the  patient's  head  well  supported,  strong  pressure  is  made  downward  upon  the  molar 
teeth,  while  with  the  fingers  the  chin  is  forced  upward,  the  condyloid  processes  are  re- 
leased from  their  false  position  and  are  drawn  back  into  the  glenoid  cavity  by  action  of  the 
muscles.  The  jaw  should  be  retained  in  place  for  two  or  three  weeks,  nourishment  being 
administered    through   a   tube   passed   behind   the  molars. 


(14) 


COPYRIGHT,     1905 
BATTLE     &.     CO, 


J^o/'rzt-  of 

l?jslocat/on 


Unilateral  Dislocation  of  Cervical  Vertebra 


The  articular  surface  on  one  side  of  the  upper  vertebra  is  carried  upward  and  forward 
until   its   posterior    edge    has    passed    the    anterior    edge    of    the    one    with   which    it   articulates. 

TREATMENT 

Treatment  consists  of  simple  traction  upon  the  head,  counter  extension  being  made  by 
the  weight  of  the  body,  followed  by  rotation  of  the  face  toward  the  dislocated  side.  Or  bet- 
ter still,  abduct  the  head  still  further  to  free  the  articular  processes,  then  rotate  backward 
into  place.  Traction  when  used  should  be  in  the  direction  of  the  long  axis  of  the  upper  seg- 
ment.    A  plaster  of  Paris  dressing  is  all  that  is  needed  in  the  way  of  retentive  apparatus. 


COPYRIGHT,    IBOE, 
BATTLE     &     CO. 


(  15  ) 


Jterno-tfyo/d. 


5terno> 
Mastoid 


Upward  Dislocation  of  Sternal  End  of  Clavicle 

The  end  of  the  clavicle  rests  on  the  upper  border  of  the  sternum  in  contact  with  the 
sterno-hyoids  and  sterno-mastoid,  and  may  pass  behind  the  sternal  portion  of  the  sterno- 
mastoid.  The  anterior  and  posterior  sterno-clavicular  ligaments  are  torn  and  the  meniscus 
accompanies    the    clavicle;    there    is    frequently  dyspnea    and   dysphagia. 

TREATMENT 

Reduction  is  made  by  drawing  the  shoulder  outward,  and  making  pressure  downward 
and  outward  upon  the  sternal  end  of  the  clavicle.  Fixation  of  the  shoulder  by  various  dress- 
ings  and   the   recumbent   position    constitutes   the    treatment.      Recurrence    frequent. 


(16) 


COPYRIGHT,    190S, 
BATTLE     &     CO. 


A?as  to/a? 


Dislocation  of  Sternal  End  of  Clavicle 
Downward  and  Forward 

The  articular  surfaces  are  completely  separated,  and  the  posterior  articular  surface  of 
the  clavicle  rests  upon  the  front  of  the  sternum  near  the  median  line,  sometimes  as  much 
as    three    inches    below    the    normal    position.      Both   anterior  and  posterior  ligaments   are   torn. 

TREATMENT 

Reduction  is  effected  by  drawing  the  shoulder  outward  and  backward,  and  making  pres- 
sure upward  and  backward  upon  the  dislocated  end.  Failures  to  reduce  are  sometimes  en- 
countered, but  the  greatest  difficulty  is  to  retain  after  reduction.  Stimson  recommends  a 
figure-of-eight  bandage  about  both  shoulders,  the  turns  crossing  in  front  of  the  chest;  and 
also  a  plaster  of  Paris  dressing. 


COPYRIGHT,    1905, 
BATTLE    &     CO. 


(17) 


Cprsco/'d 
Process 

Jub- 
S&pitforia 
/£ 

Head  of 
Numeru& 


rJYerve 


Yil/ary 
Artery 


tetissrmttS' 
Dorsi  M 


Subcoracoid  Dislocation  of  the  Humerus 

In  this  injury  the  capsule  is  torn  at  its  inner  and  lower  portion  and  extends  along  the 
inner  and  lower  border  of  the  glenoid  fossa.  The  subscapularis  is  frequently  torn  more  or 
less  widely,  the  upper  portion  lying  on  the  head  of  the  humerus;  the  other  shoulder  muscles 
are  frequently  more  or  less  lacerated.  The  head  of  the  humerus  lies  against  the  edge  of 
the  glenoid  fossa  or  back  against  the  neck  of  the  scapula,  and  either  close  up  against  the 
beak  of  the   coracoid   or   lower   down   according  to  the  amount  of  untorn  capsule  and  the  tension. 

TREATMENT 

Kocher's  method  of  reduction  is  the  best  of  several  and  is  least  apt  to  hurt  the  axillary 
vessels.  This  consists  of  three  movements  or  manipulations.  External  rotation  of  the  fore- 
arm, the  elbow  being  held  close  to  the  side;  carry  the  elbow  forward  and  raise  it  in  the  sag- 
ittal plane,  the  forearm  still  being  held  in  external  rotation;  internal  rotation  of  the  fore- 
arm. This  method  failing,  attempt  traction  downward  and  outward,  the  elbow  not  being 
raised  higher  than  the  shoulder,  combined  with  direct  pressure  on  the  head.  Failing  this, 
etherize  and  repeat  the  attempts.  Occasionally  the  joint  has  to  be  opened  in  order  to  effect 
reduction. 

After  reduction  joint   should    be   kept   at   rest    for    three    weeks. 


(18  ) 


'Acromion 
'Process 

iXCoracoid Process 

Ten  dor)  of 
Toraco  •  Brachials 

'Long Head  of  Biceps 

Glenoid  Cavity 

Short  Headof3iceps 


Mead  of  Humerus 


Zat/ssimu& 
Dorsi 


Subglenoid  Dislocation  of  the  Humerus 

The  tear  in  the  capsule  is  generally  smaller  than  that  in  the  sub-coracoid  variety,  and 
differs  from  it  in  not  extending  so  far  upward.  The  head  of  the  humerus  varies  somewhat  in 
its  position  but  generally  lies  below  and  in  front  of  the  glenoid  fossa  and  beneath  the  untorn 
subscapularis. 

TREATMENT 

The  best  treatment  is  traction  on  the  arm  as  found,  -with  the  fist  in  the  axilla  to  press 
the  head  of  humerus  outward,  followed  by  necessary  upward  pressure  at  the  elbow.  Care 
must  be  taken  not  to  overstretch  the  structures,  or  much  damage  may  result  to  the  axillary 
vessels.      Fixation    for   three    or    four   weeks   constitutes   the   remainder   of   the   treatment. 


COPYRIGHT,     160! 
BATTLE     &     CO. 


(19) 


Dislocation  of  Elbow  Backward 

The  internal  lateral  ligament  is  always  torn  and  the  rent  extends  along-  the  anterior  liga- 
ment. The  external  lateral  ligament  is  usually  torn  or  entirely  detached  from  the  humerus. 
The  tip  of  the  internal  epicondyle  is  frequently  torn  off  and  displaced  upward  and  backward. 
The  flexor  muscles  of  the  hand  are  sometimes  freely  torn  from  the  humerus,  the  brachialis 
anticus  may  be  lacerated  or  torn  clear  across.  The  capsule  at  the  back  of  the  external  condyle 
is  torn  off,  and  by  retaining  its  continuity  with  the  periosteum  frequently  strips  it  up  and 
folds  it  over  the  head  of  the  radius.  The  displacement  varies  greatly.  The  top  of  the 
coronoid  process  may  rest  against  the  lower  and  posterior  surface  of  the  trochlea  while  the 
radius  remains  in  place,  or  both  bones  may  be  dislocated,  the  radius  following  the  ulna  in 
the    backward    excursion. 

TREATMENT 

Place  the  knee  on  the  inner  side  of  the  elbow  joint,  in  the  bend  of  the  arm,  and  take  hold 
of  the  patient's  wrist,  meanwhile  bending  the  arm.  Press  on  the  radius  and  ulna  with  the  knee 
so  as  to  separate  them  from  the  humerus,  thus  allowing  the  coronoid  process  to  slip  from 
the  posterior  fossa  of  the  humerus;  while  this  pressure  is  supported  by  the  knee,  the  arm 
is  to  be  forcibly  but  slowly  bent  and  the  reduction  is  soon  effected.  It  may  also  be  accom- 
plished by  forcibly  bending  the  arm  around  some  convenient  post.  Should  the  olecranon  be 
fractured,  special  treatment  looking  to  the  correction  of  that  complication  is,  of  course,  to 
be   adopted. 


(20) 


COPYRIGHT,    1©05, 
BATTLE     &,     CO. 


Torn  attachment 
of  Triceps 


Forward  Dislocation  of  the  Elbow- 
in  the  complete  form  of  this  injury  the  upper  surface  of  the  olecranon  rests  against  the 
front  of  the  capitellum,  the  annular  and  interosseous  ligaments  remain  whole,  while  the  an- 
terior and  posterior  and  both  lateral  ligaments  are  almost  invariably  ruptured.  The  triceps 
is  completely  torn  from  its  attachment  to  the  olecranon,  while  the  two  radial  extensor  muscles 
and  all  the  muscles  arising  from  the  epicondyle  are  generally  detached.  The  ulnar  nerve  is 
often  torn  behind  the  condyle. 

TREATMENT 

Reduction  is  usually  best  effected  by  flexing  the  arm  to  a  right  angle,  and  pulling  the 
upper  ends  of  the  bones  back  into  place  by  means  of  a  strap  passed  around  the  front  of  the 
forearm    close    to    the   elbow. 


COPYRIGHT,    160 
BATTLE     i.     CO. 


(21  ) 


Forward  Dislocation  of  Head  of  Radius 

The  head  of  the  radius  rests  in  partial  flexion,  upon  the  anterior  surface  of  the  external 
condyle  above  and  to  the  inner  side  of  its  normal  position.  The  capsule  is  torn  in  front  close 
to  its  attachment  to  the  humerus,  the  ligament  remains  untorn  and  encircles  the  neck  of  the 
radius,    while    the    head    projects    through    the    rent    in    the    capsule. 

TREATMENT 

Reduction  is  effected  by  traction  upon  the  radius  at  the  wrist,  the  forearm  being  supi- 
nated  and  extended,  combined  with  pressure  upon  the  head  of  the  radius.  Fixation  in  the 
flexed  position  for  two  or  three  weeks  constitutes  the  after-treatment,  followed  by  passive  motion. 


(  22) 


Dislocation  of  Head  of  Radius  Outward 

(Trochlea  is  much  broadened.) 

The  external  lateral  ligament  is  generally  torn,  taut  there  are  no  special  characteristic 
symptoms.  The  limb  is  generally  partly  flexed  and  pronated,  the  movement  of  the  joint 
restricted,  and  the  head  of  the  radius  can  be  felt  out  of  its  customary  place.  The  injury  is  a 
rare  one. 

TREATMENT 

Reduction  is  effected  by  adduction  of  the  forearm  and  direct  pressure  on  the  head  of  the 
radius;   it  is   usually   easy. 


COPYRIGHT,    1005 
BATTLE   &    CO. 


(23  ) 


11 


JUadius 
Semilunar 
Os  Magnum 


Pronator 
Quad  rat  us 


Middle 
Metacarpal 


flexor 
Tendon 


Ulna. 
Cuneiform. 

Unciform. 
Fourth 


«/ 


(Sem/Junar 


Forward  Dislocation  of  the  Carpus 


Longitudinal  Section  through. 

a.  Radius,   O.s   Magnum  and  Semilunar. 

b.  Ulna,  Unciform  and  Cuneiform. 

This  peculiar  and  rare  affection  is  of  a  spontaneous  nature  and,  as  the  limb  generally  ac- 
quires its  full  usefulness  as  soon  as  the  skeleton  attains  its  growth,  the  objection  to  opera- 
tive interference   is  obvious. 

TREATMENT 

Reduction  is  impossible,  as  there  is  so  much  alteration  in  the  shape  of  the  bones.  Made- 
lung,  after  prolonged  attempts  to  improve  the  position  with  dressings,  etc.,  did  no  good  beyond 
relieving  pain.  Finally,  he  limited  his  efforts  to  improving  the  strength  of  the  arm  in  all  its 
parts,  and  the  wearing  of  an  adjustable  leather  bracelet  moulded  to  the  forearm,  thus  pre- 
venting  movement   of  the   wrist   and    leaving   the   fingers  free. 


(  24  ) 


COPYRIGHT.    1905. 
BATTLE   A.     CO. 


F/exor 
Tendon 


Dislocation  of  the  Thumb 

a.  Lateral   View. 

b.  End    View    of    Right    Thumb. 

Long-  Flexor  Tendon  is  displaced  to  inner  side. 

The  head  of  the  phalanx  leaves  the  articular  surface  of  the  metacarpal  bone  and  rests 
upon  the  dorsal  surface.  The  external  lateral  ligament  is  torn  and,  usually,  the  internal  one. 
The  flexor  tendon  may  remain  in  position  tightly  stretched,  or,  as  is  more  commonly  the 
case,  it  slips  to  the  inner  side  of  the  metacarpal  bone.  The  head  of  the  metacarpal  projects 
through  the   rent   in   the    capsule. 

TREATMENT 

Reduction  is  made  by  pressing  the  metacarpal  bone  toward  the  hand  and,  while  maintain- 
ing the  phalanx  in  rectangular  dorsal  flexion,  pressing  its  base  down-ward  toward  the  end  of 
the  metacarpal  bone  and  flexing  when  the  proper  level  is  reached.  Retention  for  a  couple  of 
weeks    constitutes    the    remainder    of    treatment. 


COPYRIGHT,    IOC 
BATTLE    &    CO. 


(25) 


Obturator 
Internum 


Dorsal  Dislocation  of  Femur 

Head  of  Femur  Lies  Behind  Acetabulum. 

The  capsule  in  the  lower  posterior  part  is  torn,  and  may  be  torn  from  the  femur  and 
rarely  from  the  acetabulum.  The  anterior  portion  of  the  capsule  and  the  ilio-femoral  ligament 
usually  remains  untorn.  The  ligamentum  teres  is  usually  torn  from  its  attachment  to  the 
femur.  The  quardratus  femoris  is  usually  completely  torn  across;  the  gemelli,  pyriformis  and 
obturator  externus  are  generally  torn,  while  the  gluteus  and  obturator  internus  escape.  The 
head  of  the  femur  as  a  rule  rests  close  to  the  margin  of  the  acetabulum  or  may  overlap  it, 
and   may   be   displaced   a   variable   distance    backward    and    upward. 

TREATMENT 

Reduction  consists  of  four  consecutive  movements:  First,  forward  rotation;  second, 
flexion    to    a    right   angle;    third,    traction;    fourth,   outward    rotation. 


(26) 


COPYRIGHT.    1905. 
BATTLE    ft    CO. 


Obturator  Dislocation  of  Femur 

(Showing  effect  of  Flexion  on  Y  Ligament.) 

The  capsule  is  ruptured  on  the  inner  and  lower  side,  usually  near  the  acetabulum  and 
sometimes  extending  along  the  neck,  together  with  laceration  of  the  obturator  externus  and 
pectineus.      The    head    of    the    femur    rests    on    the  obturator  foramen  or  on  the  ramus  beyond  it. 

TREATMENT 

Reduction  is  generally  easy  by  anesthetizing  the  patient  and  then  first  increasing  the 
flexion  and  rotation,  making  traction  in  the  long  axis  of  the  limb,  and  finally  lowering  and 
rotating  inward. 


COPYRIGHT.    1905. 
BATTLE   ft    CO. 


(27) 


*5eff7/tenci'(fi03us 


Attachment 


G$jtro  crreznrus 


Forward  Dislocation  of  the  Knee 


In  the  complete  dislocation  the  injuries  are  very  extensive,  one  or  both  lateral  ligaments, 
one  or  both  crucial,  the  posterior  and  the  lateral  ligaments  of  the  patella  are  completely 
ruptured  or  torn  across.  The  posterior  muscles,  the  biceps,  gastrocnemius,  popliteus  and  even 
the  soleus  and  vastus  internus  are  lacerated  or  divided;  the  internal  and  external  popliteal 
nerves  may  be  torn  or  bruised,  the  popliteal  artery  and  vein  ruptured,  and  the  skin  of  the 
popliteal  space  torn  through.  The  overriding  of  the  femur  and  tibia  may  be  as  much  as  four 
inches. 


TREATMENT 

Reduction    is    easy    by    direct    traction    and  reposition    of   articular   surfaces, 
jury   to    the    popliteal    vessels    exists    amputation  will   be   necessary. 


If   serious    in- 


(28) 


COPYRIGHT.    1905 
BATTLE    ft    CO. 


Rectus 
Femoris 


Mi 


Dislocation  of  the  Patella  Outward 

The   patella   is    displaced    entirely   to   the   outer   side   of  the   external   condyle,    against   which 
it  rests  either  by  its   posterior  surface,  or   by   its   inner   border. 

TREATMENT 

Full    extension    of    the    knee    and    flexion    at    the    hip,    followed    by    direct   pressure    on    the 
patella   with   the   hands. 


COPYRIGHT,    1906, 
BATTLE   a   CO. 


(29) 


n 


frxternal 
Condyle 


Internal* 

Co??di/]e 


Various  Dislocations  of  the  Patella 

The  various  positions  assumed  by  the  patella  in  the  several  dislocations,  and  the  combina- 
tions effected  by  varying  degrees  of  rotation  of  the  bone  itself  upon  its  perpendicular  axis  are 
so  numerous  that  to  name  them  or  attempt  to  classify  them  would  lead  only  to  confusion  and 
a  complexity  of  terms. 

TREATMENT 

The  figure  represents  the  patella  in  its  normal  position,  the  dotted  outlines  of  the  patella 
show  the   most   frequent   positions   assumed   when   dislocated. 


(30) 


COPYRIGHT,    1905. 
BATTLE  ft    CO. 


7endon  of 
Tib/alt's 
Anticus 

JSktensw 

■Propria 

7/rCernal_ 
JTalleolut 


T&ncto 
ch  /lies 


AstrdLgaltts 


Tendon  of 
Extensor 
<ngus  cf/p/torutn 

J&ternal Malleolus. 

JTeadof 
A$tragaJu$ 


Scaphoid 


Jlnnular 
Ligament 


Subastragaloid  Dislocation  of  the  Ankle  Outward 

In  the  complete  outward  form  the  head  of  the  astragalus  rests  against  the  inner  side  of  the 
scaphoid,  while  the  posterior  tip  is  engaged  in  the  groove  in  the  upper  surface  of  the  calcaneum; 
the  lower  part  of  the  internal  lateral  ligament,  the  interosseous  ligament,  and  the  astragalo- 
scaphoid  ligament  are  ruptured,  and  the  posterior  and  outer  part  of  the  external  malleolus  are 
generally  broken. 

TREATMENT 

Reduction  when  accomplished  is  best  made  by  flexion  of  the  knee,  and  the  application  of 
pulleys  with  traction  downward  and  forward,  together  with  coaptative  pressure  on  foot  and 
ankle.      Removal   of   the   astragalus   is   necessary  in  many  cases. 


COPYRIGHT,    1905. 
BATTLE  a  CO. 


(31) 


BROMIDIA 


IODIA 


FORMULA — Bromidia  combines  Chloral 
Hydrate  91  grs.,  Potassium  Bromide  91 
grs.,  Cannabis  Indica  1  gr.,  and  Hyoscya- 
mus  1  gr.  in  each  fluid  ounce. 

INDICATIONS  —  Sleeplessness,  Nervous- 
ness, Neuralgia,  Headache,  Convulsions, 
Colic,  Mania,  Epilepsy,  Irritability,  etc. 

It  does  not  lock  up  the  secretions. 

DOSE — One-half  to  one  teaspoonful  in 
water  or  syrup  every  hour  until  sleep 
is  produced. 


FORMULA — Iodia  is  a  combination  of  ac- 
tive principles  obtained  from  the  green 
roots  of  Stillingia,  Helonias,  Saxifraga, 
Menispermum  and  Aromatics.  Each  fluid 
drachm  also  represents  2%  grains  Iod. 
Potas.  and  1%  grains  Phos.  Iron. 

INDICATIONS-^-Syphilitic,  Scrofulous  and 
Cutaneous  Diseases,  Dysmenorrhoea, 
Menorrhagia,  Leucorrhoea,  Amenor- 
rhoea,  Impaired  Vitality,  Habitual 
Abortion  and  General  Uterine  Debility. 

DOSE — One  or  two  teaspoonfuls  (more  or 
less,  as  indicated) ,  three  times  a  day, 
before  meals. 


PAPINE 


ECTHOL 


FORMULA — Papine  is  the  anodyne  prin- 
ciple of  Opium,  the  narcotic  and  con- 
vulsive elements  being  eliminated,  and 
is  derived  from  the  concrete  juice  of 
the  unripe  capsules  of  Papaver  Somni- 
ferum.  One  fluid  drachm  is  equal  in 
anodyne  power  to  one-eighth  grain  of 
Morphia.  It  produces  no  tissue  changes, 
no  cerebral  excitement,  no  interference 
with  digestion. 

INDICATIONS— The  same  as  Opium  or 
Morphine,  with  less  tendency  to  cause 
Nausea,  Vomiting,  Constipation,  etc.  A 
safe  opiate  for  children. 

DOSE — For  adults,  one  teaspoonful;  for 
children  under  one  year,  2  to  10  drops. 


FORMULA — Contains  the  active  principles 
of  Echinacea  Angustifolia,  Thuja  Occi- 
dentalis. 

INDICATED — In  all  breaking  down  condi- 
tions of  the  fluids,  tissues  and  corpuscles, 
dyscrasia  of  the  secretions,  blood  poison- 
ing or  tissue  disintegration.  In  typhoid, 
morbific  or  eruptive  fevers,  small-pox, 
scarlet  fever,  erysipelas,  etc.,  carbuncles, 
boils,  gangrenous  wounds,  ulcers,  ab- 
scesses, etc.,  stings  of  insects,  bites  of 
snakes,  etc.  Valuable  as  a  local  applica- 
tion in  all  pustular  formations,  as  well 
as  fresh  cuts. 

DOSE — One  teaspoonful  four  times  a  day, 
or  oftener,  as  indicated. 


Battle  <&  Co. 


CHEMISTS'  CORPORATION 

(Established  1875) 


ST.  LOUIS,  MO.,  U.  S.  A. 


Printed  in  U.  S.  A. 


(  32) 


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Battle  &   co.,    St.    L0 


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Fractures  and  riKinr^     :' 

lllllllllllllllll  liS»in.n^arts  lfl  colo 


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